No specific underlying cause will be detected in 90 per cent of women who experience menopause prematurely, but some factors associated with POI include:1,4

·       auto-immune disease: this accounts for 5 per cent of POI cases and is associated with other types including underactive thyroid, type 1 diabetes, and Addison’s disease;

·       genetics: abnormalities of the X chromosome (eg Turner syndrome where one X chromosome is absent) or other genes affecting sex hormone function, along with Fragile X syndrome and galactosaemia;

·       infections: a rare cause, but mumps and tuberculosis are the most likely triggers, with malaria, varicella, and shigella also possible;

·       surgery: removing the ovaries removal with or without hysterectomy can trigger an abrupt onset;

·       cancer treatments: chemotherapy or radiotherapy can damage the ovaries;

A 2017 study found an association between weight and POI risk. Women aged 25-42 years with a body mass index (BMI) of under 18.5kg/m2 had a 30 per cent increased risk of early menopause compared to a 18.5-22.5kg/m2 BMI. Being overweight (BMI 25.0-29.9 kg/m2) reduced risk by up to 30 per cent.5